Clinical Case

A 68 year old female with a previous history of high blood pressure, T2DM and obstructive sleep apnea suffered from morbid obesity with a BMI of 43 (weight 119 Kg). A Roux-en-Y gastric bypass by laparoscopic approach was performed with good weight loss and metabolic response.

Eight years after surgery, she complained of recurrent abdominal pain and abdominal distention. At this time she had a weight loss of 56kg (23,14 kg/m2).

Further investigation was performed with a CT Scan that showed a focal bowel dilation at the jejuno-jejunal anastomosis, and a laparoscopic revision was proposed.

Treatment

A total of three trocars were used. One of 12mm at the umbilicus placed by Hasson technique for a 30º scope and one of 5mm at each flank. Inspection of the small bowel revealed a focal dilation of the alimentary loop with some twist of the gut.

After accommodation in a peristaltic direction it was clear that the bowel distal to the anastomosis was normal. It was corroborated that this maneuver allowed a correct bowel transit because the dilated zone disappeared with the peristalsis.

Re-exploration after some minutes supported the findings. The strategy was to perform some knots with prolene to fixate the jejunal anastomosis involving the mesentery and the small bowel.

It was confirmed that the knots were effective because the bowel maintained the position at the end of the procedure.

Outcome

At the postoperative period, she developed an abdominal wall hematoma however, she started oral intake 12 hours after surgery and left the hospital the next day. At the last follow up she was asymptomatic.